Journal of Clinical and Translational Science

Abstract Objective: Physician-scientists are a diminishing subset of the pediatrician work force, uniquely trained to advance child health through scientific discovery. The current financial landscape of academic medical centers makes traditional resource-intensive training programs untenable. Continued renewal of this critical pediatric workforce requires new resource-efficient methodologies. Thus, we evaluated the impact of the NICHD supported Vanderbilt K12 program, a personalized, intensive training program. Study Design: We tracked academic outcomes for scholars with K12 appointments between January 2015 and December 2022. Our primary outcome was receipt of a mentored career development award (K08 or K23). Successful transition from mentored to independent NIH funding (K to R transition) was used as a secondary outcome. Academic outcomes for faculty participating in a large, institutional training program, the Vanderbilt Faculty Research Scholars program (VFRS), served as a comparison cohort. A complementary qualitative evaluation of the K12 program was performed. Results: K12 scholars earned career development awards (73%) at an equivalent rate to VFRS faculty (71%) and transitioned K to R funding at equivalent rates, 45% of K12 scholars compared to 50% for VFRS. Qualitative analysis demonstrated K12 scholars valued a personalized training program that incorporated self-efficacy and adaptability, key tenets of Social Cognitive Career Theory. Conclusion: Personalized physician-scientist training programs may enhance efficient utilization of research resources in Pediatric academic departments and serve as a viable alternative to traditional programs. Our qualitative evaluation suggests scholar self-efficacy and adaptability can be achieved through a personalized training program.

Background: Parenthood in medicine is an experience fraught with challenges that begin in the pre-conception phase and persist as physician-parents navigate their dual role. Methods: This study aims to understand the experiences of physician-parents (both childbearing and non-childbearing) returning to work after parental leave. Physicians, including residents, affiliated with the University of Toronto Department of Medicine internal medicine division who had a child within the last ten years were invited to participate in a self-administered electronic survey from June2022 to 30June 2023. Data were summarized using descriptive statistics. Results: Twenty-nine respondents took part in the survey; 79% were staff physicians while the remaining were trainees at the time of the survey. At the time their first child was born, 48% were staff members and 52% were trainees. The median duration of parental leave was 5 months (range 1-12 months). Among those for whom lactation was applicable, 76% reported that they continued their lactation efforts on returning to work, while 24% chose not to. Thirty five percent (35%, n=6/17) of respondents cited that they were not provided with duty hour modifications when required. Many respondents (46%) felt guilty about burdening their co-workers for requesting accommodations for childcare. When requested to rate their experiences of balancing their personal and professional lives on a scale of 1-10 (1 being impossible to maintain and 10 being extremely easy to maintain), most respondents (66%) chose a rating of 5 or less. Conclusion: This study supports previous findings that physician-parents face a myriad of challenges integrating their roles in medicine and parenthood. A change in culture is required to support and normalize parenthood for physicians and foster sustainability and productivity in academic medicine.

The iTHRIV Scholars Mentored Career Development Program initiated an Internal Grant Review (IGR) program in 2020 for current and recently graduated Scholars seeking funding through K and R awards from the NIH. The IGR program is designed to replicate the NIH review process and provide Scholars the opportunity to receive valuable feedback on their applications prior to NIH submission. A key characteristic of the program is the integration of REDCap, enabling automation and year-round offering while improving tracking and reporting efforts and capabilities. Results of the program have been overall positive, both in proposal development and participant feedback. IGR is a sustainable, valuable resource for early-career faculty competing for limited resources in the pursuit to become independently funded clinical translational scientists.

Background: The rapidly evolving United States (U.S.) health and science policy landscape in 2025 may have heterogeneous effects on academic medicine, biomedical research, physician workforce development and patient care. Research Question: How do academic pulmonary and critical care medicine (PCCM) physicians perceive U.S. health and science policy changes and which changes do they consider most influential on research, trainee education and clinical care? Study Design and Methods: We conducted a prospective survey from March 27, 2026 through April 29, 2026 among selected faculty at U.S. academic PCCM programs as part of the Alliance of Scholars and Professionals for Innovation, Research, and Education in Pulmonary and Critical Care Medicine (ASPIRE-PCCM). Results: Ninety-four of 99 ASPIRE-PCCM panel members completed the survey (response rate 95%), representing 18 of 19 ASPIRE-PCCM wave 1 institutions. All respondents reported the rate of changes in U.S. federal health and science policy in the first half of 2025 as 6 or higher on a scale of 1 ("typical pace of change") to 10 ("most change in my lifetime"), with 89 (96%) evaluating the changes as harmful or very harmful. Respondents identified cancellation of research grants, disruptions and changes to NIH scientific review processes, and changes to visa and immigration policies as key factors affecting early career recruitment. Reported negative effects on quality of care included increased vaccine hesitancy, changing reimbursement structures, and diminished research capacity. State-level and non-governmental efforts, including professional society advocacy, institutional bridge funding and personal advocacy efforts were identified as partially mitigating harms. Despite these concerns, 72% of respondents reported that would still pursue careers in PCCM. Interpretation: Academic pulmonary and critical care physicians reported challenges following recent U.S. health and science policy changes that may be mitigated, but not neutralized, by institutional, professional-society, and individual actions.

Despite the numerous benefits associated with higher dietary quality, many older Veterans do not meet national dietary recommendations. Existing programs are not typically tailored for older Veterans who may experience physical and environmental limitations that hinder their ability to access and prepare healthy foods. This project piloted the incorporation of age-friendly, tailored, virtual nutrition education into an existing health promotion program for older Veterans. Programming followed an iterative design process over two years. Year 1 included 14 weeks of virtual nutrition education on healthy aging paired with weekly produce bags and recipe suggestions. In Year 2, virtual nutrition education shifted to more hands-on learning emphasizing basic meal preparation and adaptive cooking strategies for mobility limitations. Produce distribution in Year 2 shifted to a farmer's market model, based on feedback from year 1, allowing participants to self-select items. Primary outcomes included program satisfaction, dietary intake assessed via 24-hour recall to calculate the Healthy Eating Index (HEI-2015), and health-related quality of life (PROMIS Global Health). Findings demonstrate the feasibility and acceptability of a virtual nutrition program incorporating age-friendly cooking instruction and adaptive strategies to improve dietary quality among older Veterans.

Importance: Dyslipidemia, hypertension, and diabetes are highly prevalent conditions for which medical nutrition therapy (MNT) is guideline-recommended, yet access remains limited, and real-world evidence on technology-enabled MNT models at scale is sparse. Objective: To characterize lipid, blood pressure, and glycemic outcomes among adults receiving virtual MNT (vMNT) across three cardiometabolic conditions. Design: Retrospective cohort study of adults with a first Nourish appointment before November 2025, followed for 6 months. Setting: National vMNT platform. Participants: Adults meeting enrollment criteria for dyslipidemia, hypertension, or diabetes and remaining engaged in care with [&ge;]1 follow-up measurement at 3 or 6 months. Final cohorts: dyslipidemia (n=6,501), hypertension (n=13,704), diabetes (n=2,444); 18,965 unique patients overall. Exposure: vMNT delivered by a registered dietitian via telehealth visits, with technology-enabled support between visits. Main Outcomes and Measures: Outcomes were LDL cholesterol, total cholesterol, HDL cholesterol, and triglycerides (dyslipidemia); systolic and diastolic blood pressure (SBP, DBP) (hypertension); and HbA1c (diabetes), assessed at enrollment, 3, and 6 months. Weight was a secondary outcome. The proportion achieving guideline-recommended targets (HbA1c <7.0%, SBP <130 mmHg) was also assessed. Results: Among 18,965 patients (mean [SD] age, 42.9 [11.6] years; 15,770 [83.2%] female), significant changes from baseline to 6 months included: LDL cholesterol (-14.0 mg/dL [SE, 0.56]); total cholesterol (-19.4 mg/dL [SE, 0.61]); HDL cholesterol (-0.5 mg/dL [SE, 0.15]); triglycerides (-28.6 mg/dL [SE, 1.06]); SBP (-5.5 mmHg [SE, 0.16]); DBP (-4.5 mmHg [SE, 0.11]); and HbA1c (-1.37 percentage points [SE, 0.04]) (all P<.001). Among those with elevated SBP, 57.3% achieved <130 mmHg by 6 months; among those with elevated HbA1c, 54.7% achieved <7.0%. Outcomes among patients with stable medication regimens were similar to the full cohort. Conclusions and Relevance: In this study of 18,965 patients, vMNT delivered through a technology-enabled care model was associated with clinically meaningful improvement across three prevalent cardiometabolic conditions. These findings support technology-enabled virtual care as a scalable approach to delivering effective MNT.

Background Training in grant proposal writing is an essential component of professional development for academic scientists in the biomedical and behavioral sciences. Despite the expansion of inter- and intra-institutional grant writing coaching groups as an approach to honing these skills, specific features that enhance or limit coaching group effectiveness have not been rigorously studied. Methods Qualitative inerviews were conducted with a subset of early-career investigators (n=204 and coaches (n=36) engaged in a national, U.S. based, group-randomized trial of grant writing coaching groups to test the effects of two variables on submission and funding of national-level proposals: (1) coaching duration (regular/extended dose) and (2) mode of engaging a scientific advisor (someone with content-aligned expertise) in the coaching process. This report focuses on interviews conducted upon completion of the regular coaching dose - 5 months of biweekly, group-based coaching sessions to support active proposal writing. Interviews were designed to identify which coaching group elements were perceived to be the most critical. Transcribed interviews were analyzed using deductive (participants) or open (coaches) coding to identify themes. Results Triangulation of results from participant and coach interviews showed strong concordance that coaches, peers, and scientific advisors all played key roles in supporting intervention efficacy. Sufficient alignment of scientific fields and/or methodologies among group members was important, although breadth of perspectives was also valued. Other critical group features were skilled and well-organized coaches, detailed feedback, peer-to-peer support (technical and psychosocial), and clear expectations for group functioning. Factors attenuating impact included variation in participants' engagement and "readiness to write," within-group mismatches of expertise or grant mechanisms, and limited research support at some participants' home institutions. Conclusion This study identified key elements of successful grant writing coaching groups and potential barriers to their effectiveness, while yielding insights about tailoring this approach for individuals at different stages of proposal development.

Public data sharing in immunological and clinical research is essential for transparency, reproducibility, and secondary analysis. However, many datasets in repositories such as ImmPort lack sufficient structured data to enable reuse. ImmPort's Assessments and Lab Tests templates -- which capture critical clinical information -- are often incomplete or omitted due to their complexity and the manual effort required. To address this challenge, an application with a graphical user interface requiring no programming was developed to facilitate population of these templates. The tool streamlines the submission process by reducing time and complexity for data contributors while ensuring template formatting. It integrates ImmPort files, study-specific data files, and a curated data dictionary to automate the mapping of study variables to the required fields within each template. The tool was evaluated on seven ImmPort studies with diverse designs. It successfully generated submission-ready templates that passed ImmPort's internal validation and will be incorporated into the repository. By improving the feasibility and completeness of templates, this approach enhances the quality, findability, and reusability of data within ImmPort.

Background: Data from National Health and Nutrition Examination Survey (NHANES) cycles 1988-1994 and 1999-2004 show a declining trend in the adherence to Dietary Approaches to Stop Hypertension (DASH) among adults. Since then, DASH evidence, dietary guidelines, and public-facing dietary resources have advanced, but whether national DASH adherence has improved is uncertain. Methods: We extended the Mellen et al. NHANES analysis among 14,163 adults with self-reported hypertension (N=6,914, 2003-2010, N=7,249, 2011-2018). DASH score included 9 nutrient components: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium, and sodium, with adherence defined as a score 4.5. Survey-weighted multivariable models compared DASH score, adherence, and nutrient-threshold attainment across periods. Results: In 2011-2018, U.S. adults with self-reported hypertension represented 76.2 million individuals (33.8%). Multivariable-adjusted DASH adherence declined from 22.1% in 2003-2010 to 18.6% in 2011-2018 (p=0.003), and mean DASH score declined from 2.98 to 2.85 (p=0.007). Adjusted odds of adherence were lower in 2011-2018 compared with 2003-2010 (OR, 0.78; 95% CI, 0.67-0.91; p=0.002). Adherence was lower among non-Hispanic Black adults (OR, 0.70; 95% CI, 0.59-0.84), adults with BMI 30 kg/m2 (OR, 0.61; 95% CI, 0.51-0.73), and adults with prior stroke (OR, 0.71; 95% CI, 0.56-0.89). Total fat and sodium threshold attainment declined from 20.9% to 18.7% and 13.8% to 11.8%, respectively. Conclusions: DASH adherence among U.S. adults with self-reported hypertension declined from 2003-2011 to 2011-2018. Implementation strategies should identify barriers to adoption and address the full DASH dietary pattern.

Background Pediatric neurocritical care (PNCC) has emerged as a distinct field, and many hospitals have moved to establishing dedicated PNCC programs. How practice change is implemented within these programs is not well understood. This study had two objectives. First, we sought to understand the barriers and facilitators of practice change in PNCC from the perspectives of the multiprofessional clinicians who deliver it. Second, we sought to characterize how well the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) implementation determinant framework captures them. Methods We conducted semi-structured interviews with a purposive sample of clinicians involved in PNCC at three U.S. academic medical centers. The interview guide was developed using i-PARIHS to organize barriers and facilitators of practice change across the innovation, recipients, context, and facilitation constructs. We applied framework analysis, combining deductive i-PARIHS, study-specific, and inductively derived categories. Two coders independently indexed the transcripts and reconciled them to consensus, with first-author adjudication. Preliminary site-level findings were validated with participants. Results We interviewed 33 clinicians: 24 physicians, 7 nurses, and 2 advanced practice providers. Most determinants of practice change mapped to existing i-PARIHS constructs, but three were not adequately captured by the framework as currently specified. The most consequential was an interprofessional authority gradient that determined whose preferences prevailed when intensive care, neurology, and neurosurgery disagreed. The other two were clinician autonomy, which served as the lens through which the acceptability of a change was judged, and the affective state clinicians bring to practice change. Receptivity depended more on recipients' values, prior experience, and capacity to absorb change into a demanding workflow. Facilitation was variable, frequently under-resourced, and dependent on credibility across professional groups. We translated these findings into three propositions linked to implementation strategies and outcomes. Conclusions Participants attributed practice change in PNCC more to the recipients of change, the multiprofessional context, and the availability of facilitation than to the strength of evidence for a given practice. i-PARIHS captured most barriers and facilitators well but may be adapted in this setting. Credible, resourced, authority-sensitive facilitation may improve the prospects for sustained practice change as institutions develop PNCC programs.

Background AI use is growing by HPE scholars, and disclosure of that use is required by scientific ethics and journal policy. In spite of growing unease about the meaning, and meaningfulness, of AI-use disclosures in published manuscripts, little is known about how authors represent their AI use in published disclosure statements. Without such understanding, we are ill-equipped to redirect disclosure practices for increased sufficiency and sincerity, undermining efforts towards transparency in the era of AI-supported scholarship Methods In this descriptive qualitative study, 18 HPE researchers with experience disclosing generative AI use in publications from 2025-2026 were interviewed using Zoom. Data collection and thematic analysis proceeded iteratively, exploring participant experiences with AI use, their disclosure decisions, and evolving disclosure practices. Results Participants reported a wide range of experience writing AI-use disclosures (from 1-16 disclosures/participant); in total 31 published disclosures were shared by participants and discussed during the interviews. Our analysis identified four themes: A spectrum of AI uses; Multi-factorial disclosure decisions; Discrepancies between actual and disclosed use; and Emotions around disclosure. Discussion AI-disclosure takes place at the intersection of shared ethical principles and situated pragmatic concerns. Disclosure is both an intellectual and an emotional practice, changing over time as AI use evolves and journal expectations develop. More generative uses may provoke divisive responses and are related to uncertainty about how to disclose, concern about disclosure penalties, and periodic use-disclosure discrepancies. Understanding how researchers are navigating these complexities may help the HPE community articulate clearer guidance for transparent and meaningful disclosure of AI-use in scholarly work. Reflective methodologies can help bring these issues to the surface of ongoing conversations about AI use.

Background & Aims Personalized nutrition has the potential to improve nutritional intake and clinical outcomes in hospitalized patients by adapting to individual dietary needs and preferences. Despite its promise, no personalized nutrition product (PNP) for hospitalized patients is currently available. This study aimed to assess the acceptability of PNPs among hospitalized patients and hospital staff. Methods A prospective, ten-days, proof-of-concept study was conducted among in-hospital adult patients ([&ge;]18y). Study patients received a freshly 3D printed PNP, customized to match individual taste preferences and health profiles. Patients could reorder the product daily if they remained hospitalized >24h after consumption. Consumption was assessed by weighing the PNP before and after consumption. Acceptability, sensory feedback, and overall experience were evaluated using questionnaires. Hospital staff also evaluated sensory feedback and acceptability. Factors influencing consumption and liking among patients were evaluated by testing within-group differences. Correlations between consumption rates, liking and patient characteristics were assessed. Results Eighty-seven patients received 137 PNPs during the study period. The average overall liking score was 5.7 ({+/-}2.1) on a 1-9 scale, and median consumption rate was 51% [Interquartile Range 19-100]. Consumption rates positively correlated with overall liking (R2 = 0.50, p < 0.001). Patients' willingness to reorder was 3.5 ({+/-}2.3) on a 1-7 scale, and reorder rate 63%. The perceived value of a PNP service in a hospital setting (scale 1-7) was scored 5.3 ({+/-}1.7) by patients and 4.5 ({+/-}1.1) by staff. Conclusions PNPs were evaluated as moderately positive in terms of acceptability and value by both patients and staff. However, further optimization of the product is needed before evaluating clinical efficacy.

Background: Patient Decision aids (PtDAs) are important tools that support shared decision-making (SDM) between clinicians and patients, enabling patients to be more informed and engaged in decisions regarding their care. The use of PtDAs can increase patient knowledge, reduce decisional regret, and engage the clinician and patient in meaningful dialogue. Shared decision-making relies on decision aids, but how patients receive the PtDA can vary. This qualitative study elucidated patient familiarity with PtDAs and the barriers, needs, and requirements of patients to access and confidently use DAs, including when received via a clinician-facing EHR-integrated Decision Aid Navigator System (DEANS). Methods: We conducted six focus groups (FG) with participants who were recruited from two academic medical centers. Focus groups included an introduction to what a PtDA is and an exploration of how patients or family members, i.e., people who had not made a medical decision for themselves using a PtDA, but who have helped a family member, had previously used PtDAs in their healthcare. The FGs focused on PtDA-users, affordances and barriers to using PtDAs, and PtDA-user needs and requirements of a proposed DEAN patient portal. We applied Rapid Qualitative Analysis (RQA) to summarize the data, using a consensus making approach to identify emerging themes. Results: We identified three overarching themes: 1) Patients had varied familiarity with PtDAs and often confused them with general health tools, but found value in SDM, 2) Patients perceived technology accessibility, PtDA credibility, and time as barriers potentially impeding PtDA use, and 3) Patients valued flexible, user-friendly, and accessible PtDAs that support patient-led decisions, particularly when introduced by clinicians and delivered via a patient portal. Conclusion: This study provides patient-derived insights into factors that influence PtDA uptake, highlighting common misconceptions about PtDAs and identifying key patient priorities such as accessibility, flexibility, clear content, and clinician-guided usage. Patient also expected clinicians to be familiar with PtDAs, especially when the PtDA covers a complex decision. These findings can inform the development of more patient-centered SDM infrastructure and strategies to support PtDA use in clinical practice, including clinician-supported delivery, accessibility, and integration into routine care to strengthen shared decision-making.

Importance: The Medicare Physician Fee Schedule values ambulatory services using survey-based estimates of physician time, a costly process vulnerable to inaccuracy. EHR audit logs are passively and universally collected and likely meet the American Medical Association Relative Value Scale Update Committee (AMA RUC) Extant Database Standards for alternative data to inform service valuation estimates. However, audit logs' validity for estimating face-to-face time, a core component of many of the most used procedural codes, is unknown. Objective: To assess whether EHR audit logs can facilitate accurate estimation of physician-patient face-to-face time during ambulatory visits. Design: Single-site validation study pairing EHR audit logs with direct audio/video recordings of ambulatory primary care visits (reference standard). We assessed agreement between audit-log estimates and recorded visit duration with Bland-Altman analysis and mean absolute error. Setting: University of Pennsylvania Observer data repository, a multi-modal database of ambulatory visits to Penn Medicine primary care clinics including video and audio recordings, transcripts, clinical EHR data, and EHR audit-log data. Participants: 75 visits from 12 physicians with data collected between August 2023 and February 2025. Exposures: A rule-based algorithm estimated face-to-face time via clusters of physician EHR activity relative to patient check-in time. Inactivity thresholds were applied to differentiate intraservice time with no EHR activity (e.g., a physical exam) from the end of a visit, with longer thresholds used for longer visits. Main Outcomes and Measures: Duration of recorded face-to-face visit time. Results: Recorded face-to-face time averaged 31.6 minutes (SD, 13.9). The audit-log estimator was unbiased (mean bias: -0.63 minutes; 95% CI: -6.0 to 2.6; mean absolute error: 9.0 minutes) and estimated face-to-face time within approximately 2% (38 seconds) of the recorded visit time with no proportional bias (slope: 0.13; P = .25). The 95% limits of agreement were -25.7 to 24.4 minutes, and 37% of estimates fell within 10% of recorded duration. Conclusions and Relevance: In this validation study, EHR audit logs recovered unbiased estimates of ambulatory face-to-face time. Larger-scale studies are required to verify generalizability, but EHR audit logs offer a scalable means to improve the rigor of retrospective physician work relative value unit estimation. This study represents a first step in a potential paradigm shift for measuring components of the fee schedule across procedures, settings, and provider types.

BackgroundPatient education is critical to safe and effective postoperative bariatric surgery care. Large language models (LLMs) may improve access to personalized patient education but evidence regarding direct patient use in clinical settings remains limited. We evaluated BariBot, an LLM-powered educational application for patients undergoing bariatric surgery. MethodsWe conducted a prospective, single-arm mixed-methods feasibility study at a tertiary academic medical center from May 2024 to May 2025. Adult patients undergoing bariatric surgery used BariBot independently on postoperative day 1. The application provided conversational postoperative education and adapted language complexity to participants educational attainment. Outcomes included feasibility, usability, acceptability, perceived trustworthiness, and anticipated future use. Usability was assessed using the System Usability Scale (SUS). Immediately after BariBot use, participants completed a semi-structured qualitative interview assessing acceptability, perceived trustworthiness, and anticipated future use. Interview transcripts underwent thematic analysis. ResultsSixteen participants completed the BariBot use session, SUS assessment, and post-intervention interview. No technical failures prevented application use, and no participant requested early discontinuation. The median SUS score was 91.3 (IQR, 81.3-98.1), consistent with excellent perceived usability. Qualitative analysis showed that participants valued the applications immediacy, structured responses, conversational context, ability to address follow-up questions, judgement-free nature, and future availability between clinical encounters. Trust was strengthened by alignment with prior clinical guidance and perceived institutional association, although participants emphasized the need for transparency, clinician oversight, and use as an adjunct rather than a replacement of clinician guidance. ConclusionsBariBot was feasible to implement and was associated with high perceived usability and acceptability postoperatively after bariatric surgery. Larger, longitudinal, and comparative studies are needed to evaluate safety during unsupervised use and determine whether LLM-based educational applications improve patient understanding, engagement, and clinical outcomes.

Objectives: Health professions students often receive limited training on how to adjust their communication for patients whose first language is not English (LX), despite the risks for diagnosis, treatment, and patient trust. Based on Communication Accommodation Theory, we developed a brief module to improve students' awareness and knowledge of strategic communication adjustments for LX patients. Methods: We tested feasibility in a single-group, pre-post pilot study guided by the Kirkpatrick framework with undergraduate (n=22) and graduate (n=41) speech-language pathology and psychology students in Massachusetts and North Carolina. The module included instructional content, video and audio examples, interactive activities, and a podcast. Learning was assessed with knowledge checks, and self-reported facilitative and resistant accommodation with the Communication Accommodation Behavior Scale (CABS). After training, students rated their confidence and likelihood of using accommodation strategies. Results: At both sites, facilitative accommodation increased and resistant accommodation decreased significantly, with a larger decrease at the undergraduate site. Knowledge-check accuracy was high at both time points, suggesting a ceiling effect. Students reported moderate- to-high confidence in adapting their speech and high likelihood of using a learned strategy in future clinical encounters. Conclusions: A brief module can be feasibly delivered across institutions and is associated with short-term improvements in self-reported communication accommodation. Practice implications: We recommend future work evaluate whether these changes translate into clinical behavior long-term and refine knowledge-check items to better capture learning gains.

Background: Incretin-based obesity medications (IOMs) produce substantial weight loss, but the incremental benefit of structured nutritional therapy when integrated with pharmacotherapy remains unclear. Objectives: To compare 12-month weight-loss outcomes between individualized carbohydrate-reduced nutritional therapy combined with IOMs (VINT+IOM) and IOM-based care without structured nutritional therapy (IOM only). Methods: This retrospective cohort study evaluated 4,269 adults enrolled in a comprehensive telemedicine obesity care program (VINT+IOM, n=1,658; IOM only, n=2,611). Both pathways included clinician-guided medication management and behavioral coaching. The primary analysis focused on GLP-1-naive participants receiving either semaglutide or tirzepatide without switching medications during follow-up. Adjusted weight changes were estimated using longitudinal linear mixed-effects models accounting for baseline demographic and clinical characteristics. Additional analyses evaluated weight-loss responders, prior GLP-1 exposure, and medication utilization. Results: Among GLP-1-naive semaglutide users, adjusted 12-month weight loss was greater with VINT+IOM than IOM only (30.7 vs. 24.1 lb; P=0.01), with corresponding observed weight loss of 13.3% versus 11.1%. Among tirzepatide users, adjusted weight loss was 45.9 versus 34.4 lb (P=0.003), with observed reductions of 19.7% versus 15.6%, respectively. Weight-loss responder rates consistently favored VINT+IOM. In the overall cohort, including GLP-1-naive participants, those with prior GLP-1 exposure, and participants with varying medication trajectories, adjusted weight loss was 29.4 versus 21.5 lb (P less than 0.001), with observed reductions of 12.7% versus 9.6%. Greater weight loss with VINT+IOM was also observed among participants with prior GLP-1 exposure. Weight loss continued between 6 and 12 months in both pathways. Medication coverage was high, with approximately 80% of participants achieving a proportion of days covered of at least 80% in both pathways. Conclusions: Integrating individualized carbohydrate-reduced nutritional therapy with IOM-based care was associated with greater 12-month weight loss than IOM-based care without structured nutritional therapy. These real-world findings support further evaluation of individualized nutritional approaches as an adjunct to incretin-based obesity pharmacotherapy.

As health AI tools enter clinical spaces, how they are perceived by providers in safety-net environments shapes whether their benefits reach underserved populations. We examined the degree and drivers of healthcare providers' trust in health AI, whether that trust moderates perceived benefits for safety-net populations, and how providers balance benefit against concern across four specific hypothetical AI tools. We used a two-study mixed-methods design: 18 semi-structured interviews with healthcare practitioners and research leaders, followed by a survey of 229 Texas healthcare providers incorporating four vignettes describing hypothetical AI tools, each rated for appeal and concern and followed by open-ended explanation. Responses were thematically coded and stratified by self-reported trust in health AI (47.6% high trust, 52.4% low trust). Low-trust respondents most often cited building trust (50.5%) and data bias and accuracy (33.0%) as drivers of their current trust level, while high-trust respondents more often cited efficient and effective care (23.5% vs. 3.7% low-trust, p<0.001) and accuracy of data (11.8% vs. 1.8% low-trust, p=0.004); concerns about data security, governance, and the need for human oversight were raised at similar rates by both groups. When asked how AI could specifically benefit safety-net populations, both groups converged on expanding access to care (45.9% each), and none of 25 benefit-related codes differed significantly by trust group. Across all four vignettes, mean appeal ratings exceeded mean concern ratings, and high-trust providers rated every tool as more appealing and, for three of four tools, less concerning, without changing which tool ranked where relative to others. Providers exhibit conditional optimism: support is contingent on governance, human oversight, and context-sensitive implementation rather than on the technology itself. Realizing AI's promise for safety-net populations will require human-in-the-loop models, localized implementation strategies, community-informed design, and engaging providers directly in policy design and tool development.

Background: As required by the 21st Century Cures Act, all test results, including final radiology reports, are released to patients as soon as the results are finalized. However, radiology reports are primarily intended for communication between medical professionals and can often be difficult for patients to interpret, particularly in cancer care settings. We developed a tool that leverages a large language model (LLM; ChatGPT-5.2, OpenAI, San Francisco, CA) to draft a patient-friendly plain language version of imaging results (Patient-Friendly Scan Result Generation [PFSG] tool) that oncologists can incorporate into their communication with patients via patient portals. This article describes our mixed-methods study protocol. Objective: Our primary aims are to: 1) assess whether patients who receive patient-friendly versions of scan results report better understanding of their results than patients who do not; 2) assess whether introduction of the PFSG tool affects provider workload; and 3) explain how and under what circumstances the PFSG tool enhances communication and workflows, and affects patient and provider outcomes. Methods: We will use an embedded mixed-methods, prospective cohort design within a quality improvement (QI) initiative. The PFSG tool will be implemented using a modified three-wave staircase trial design, with providers in randomized cohorts of oncology disease groups progressively gaining access to the tool over the course of the study. Approximately 60 providers from 11 oncology disease focus groups will be randomized. Longitudinal provider outcomes will be measured through surveys at one month pre-implementation, one month post-implementation, and three months post-implementation. Patient outcomes will be measured cross-sectionally through surveys at one month pre-implementation (n=350) and at post-implementation result point-of-contact (n=350). Additionally, we will conduct interviews with patients and oncologists to inform the iterative design of the tool and its implementation. Results: This study was funded in September 2025 and data collection began in February 2026. As of September 2026, the PFSG tool has been rolled out to all oncology providers, with Cohort 3 post-implementation data collection beginning in August 2026. A total of 738 patient baseline surveys have been collected and patient post-implementation data collection is in progress. Conclusions: This is the protocol for a study of the implementation of a patient-friendly results tool in oncology provider workflows to facilitate improved communication of radiology results to oncology patients. The results of this study will lend evidence to the utility and acceptability of the study tool, and tools like it, to close an important oncology care gap. If the tool is shown to improve key oncology patient and provider outcomes, it may lead to development of a wider release for more general patient populations.

Background: Patient-facing AI intake chatbots can enter clinical use without regulatory review, so their errors may first surface with actual patients. Objective: To develop and pilot a remote, voice-based standardized patient (SP) method for evaluating an intake chatbot's history-taking, documentation, and patient-centeredness. Methods: Four primary care cases had Easy and Difficult variants. In Phase 1, five SPs completed 40 encounters with internal medicine residents rating portrayal fidelity. In Phase 2, SPs completed 80 encounters with a ChatGPT 4o chatbot, recorded whether critical elements were asked about and addressed satisfactorily, and rated summaries; four debriefing interviews were analyzed. In Phase 3, two blinded clinicians rated transcripts and summaries from 101 encounters (32 resident-led, 69 chatbot-led). Results: Portrayal fidelity averaged 4.52 of 5. The chatbot asked about 59.3% of critical elements in Easy versus 50.2% in Difficult variants (adjusted OR 1.49; 95% CI, 1.15 to 1.93) and addressed 73.3% versus 64.6% (OR 1.47; 1.12 to 1.93); near-ceiling summary quality did not differ. SPs reported missed information and rushed pacing. Reviewer agreement was moderate to substantial for element judgments (AC1 0.49 to 0.70) but poor for totals (ICC 0.10 and 0.21). In exploratory comparisons, residents asked about more elements (adjusted difference 12.5 percentage points; 95% CI, 7.0 to 18.1) and satisfactorily addressed more (9.2 points; 3.8 to 14.6); totals did not differ. Conclusions: SP portrayal was consistent enough for pre-clinical chatbot evaluation, and the method detected lower coverage in harder cases. Documentation ratings alone may miss conversational gaps, which require direct measurement.